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Subject:
From:
"Valerie W. McClain, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 10 Feb 2003 06:15:54 EST
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Pamela Morrison has a well-documented and well-written review of the
literature on hiv and infant feeding in Breastfeeding Review in 1999.  In
fact, I believe that every LC should read this review to further their
understanding of hiv and breastfeeding.

I think there is a serious gap of understanding in regard to this issue.  The
Orloff paper, if accurate, undermines the foundation of hiv and breastfeeding
policies.  How can you test for hiv, if the milk destroys it before you can
test it?  The Orloff paper (written by scientists from the CDC and the FDA)
could not determine whether it was pasteurization or the intrinsic factors in
human milk that killed the virus.  This is  amazing.  Hiv is inactivated by
human milk in vitro.  I believe that there are various microbiologists who
would affirm that there are certain components within human milk that
inactivate the virus.  So the $64,000 question is how can you test for this
virus if the virus is inactivated by the very substance you are testing???
Pamela, I reread the Orloff paper because I, too, thought that they were
saying that the factors that inactivated the virus were only in the fat
portion of the milk.  But let me quote from their paper:

"Human milk was delipidated by extractions with CFE, and a "skim" milk
preparation was prepared by centrifugation.  The inactivation potency was
reduced 5- to 6-fold but was not entirely eliminated by these procedures."

Thus, it would seem that the intrinsic factors are throughout the milk but
concentrated in the fat portion of the milk.  So even skimming the milk would
not necessarily inactivate these factors.  So how can we make a determination
of hiv in any milk sample?  Which has to lead me to wonder about why we are
discouraging hiv positive women from breastfeeding.  I know we have to have
proof that in vivo breastmilk will inactivate the virus.  Interestingly, I
ran across a patent that stated that recombinant human lactoferrin
inactivates the hiv virus in vitro and in vivo. Hm....so the synthetically
derived human milk component can inactivate in vivo the virus but the real
thing can't.  I wonder why?  Is the reason why based on science or economics?

What difference does it make about specificity of testing of hiv in human
milk, if that milk destroys the virus before you can quantify it?   There is
a crack in the foundation of our policies about hiv and breastfeeding.  That
crack seems very wide to me, when I see patents using human milk components
to treat or inactivate hiv/aids.  And it is getting to be a canyon-sized
crack when I see products on the market based on those patents. Valerie W.
McClain, IBCLC

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